Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice.

Abstract

OBJECTIVE:

Plantar fasciitis is a prevalent problem, with limited consensus among clinicians regarding the most effective treatment. The purpose of this literature review is to provide a systematic approach to the treatment of plantar fasciitis based on the windlass mechanism model.

DATA SOURCES:

DATA SYNTHESIS:

We offer a biomechanical application for the evaluation and treatment of plantar fasciitis based on a review of the literature for the windlass mechanism model. This model provides a means for describing plantar fasciitis conditions such that clinicians can formulate a potential causal relationship between the conditions and their treatments.

CONCLUSIONS/RECOMMENDATIONS:

Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition. Principles from this approach might also provide a basis for future research investigating the efficacy of plantar fascia treatment.

The triangle shows the truss formed by the calcaneus, midtarsal joint, and metatarsals. The hypotenuse (horizontal line) represents the plantar fascia. The upward arrows depict ground reaction forces. The downward arrow depicts the body's vertical force. The orientation of the vertical and ground reaction forces would cause a collapse of the truss; however, increased plantar- fascia tension in response to these forces maintains the truss's integrity.

The figure compares the length of the plantar fascia in different foot positions. A, The foot in a supinated (higher-arch) position. B, The foot is in a pronated (lower-arch) position. The ratio of the supination length to the pronation length is 1:1.09.